| NPI | 1851309447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 339394-1) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F300798-1) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |