| NPI | 1588060586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 430920) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 649797) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2015-11-01 |