| NPI | 1417048166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 340764) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NJ 26NO12060900) |
| 247200000X Technician, Other | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2023-03-24 |