| NPI | 1679952162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339649) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431432) |
| Enumeration Date | 2015-05-29 |
| Last Update Date | 2018-10-31 |