| NPI | 1942716469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 338383) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 598996) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2018-02-16 |