| NPI | 1346872611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 347842) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 782019-01) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2021-07-01 |