| NPI | 1407187859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 336689) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 606583-1) |
| Enumeration Date | 2010-01-25 |
| Last Update Date | 2016-09-09 |