| NPI | 1619148327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 304954) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 542942) |
| Enumeration Date | 2008-03-20 |
| Last Update Date | 2022-04-08 |