| NPI | 1740641588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339497) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2017-03-03 |