| NPI | 1952771834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F307550-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR14136100) |
| 163WE0003X Registered Nurse Emergency (Licence: NY 619839-1) | |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2016-02-10 |