| NPI | 1700982717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY 430212) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY 22516741) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2014-05-12 |