| NPI | 1447433081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304433) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY F304433-1) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F304433-1) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2024-10-30 |