| NPI | 1710328208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 662417) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 348789) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2024-01-10 |