| NPI | 1922552447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307784) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NY 628243) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2016-08-12 |