| NPI | 1578945127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F343215) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 653327) |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2018-11-01 |