| NPI | 1063616365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339314) |
| Additional Taxonomies | 175L00000X Homeopath |
| 207R00000X Internal Medicine (Licence: NY 339314) | |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2023-05-15 |