| NPI | 1730501354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 338351) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 619602) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2017-10-03 |