| NPI | 1730165192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F381315) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 466314) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2024-05-30 |