| NPI | 1033448840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC1500X Nurse Practitioner, Community Health (Licence: NY F320069) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: NY 320069F) |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2019-03-05 |