| NPI | 1538253109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 300649) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MA 267499) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2019-06-10 |