| NPI | 1396142618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 340327) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 673523) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2019-07-27 |