| NPI | 1700869575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F302898) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F302898) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2018-07-02 |