| NPI | 1528464674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F350410-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 686091-01) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2022-12-23 |