| NPI | 1396803433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F304137) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 422576) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2016-10-10 |