| NPI | 1871915314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306788) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 588861) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 588861) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NY F340928) | |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2014-03-02 |