| NPI | 1043641442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 352096) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70 012453) |
| Enumeration Date | 2013-12-10 |
| Last Update Date | 2023-11-01 |