| NPI | 1447666888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F307182) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 632371) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2016-01-27 |