| NPI | 1669897351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307197) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 672363) |
| Enumeration Date | 2014-03-04 |
| Last Update Date | 2021-04-02 |