| NPI | 1386163491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 343894) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 560416) |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2018-12-19 |