| NPI | 1760445969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F333841) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F301558) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2013-08-09 |