| NPI | 1881887537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY f304624) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 304624) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2021-02-05 |