| NPI | 1083057897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 343891) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 667448-1) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2023-04-14 |