| NPI | 1669913133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341624-1) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 649042-1) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |