| NPI | 1558515387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 556465-1) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 556465-1) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2008-11-06 |