| NPI | 1407397771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL ARNP9368599) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 693796) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 341660) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2018-06-13 |