| NPI | 1356365829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 0224404) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: NY 303984) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2017-11-01 |