| NPI | 1598141210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307395) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 646172) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2017-07-05 |