| NPI | 1902130131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F430549-1) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 17790) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2011-06-24 |