| NPI | 1649663261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 654809) |
| Enumeration Date | 2015-03-05 |
| Last Update Date | 2016-11-18 |