| NPI | 1417957523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F330581) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F300265) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F360048) | |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: NY F380329) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2010-07-08 |