| NPI | 1043268782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 342765) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017908) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2018-03-17 |