| NPI | 1386641637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F300194) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F330445) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2008-06-12 |