| NPI | 1316178320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 347012) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NY 265044-1) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2022-04-21 |