| NPI | 1376692277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F305366-1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO 179718) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2011-04-01 |