| NPI | 1588022578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY F345998-01) |
| Additional Taxonomies | 163WR0006X Registered Nurse Registered Nurse First Assistant (Licence: NY 626436-1) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2021-11-08 |