| NPI | 1366684714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341117-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 497226) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2017-02-27 |