| NPI | 1508935875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY F303060) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AK 1016) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2010-03-16 |