| NPI | 1083937460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 308857) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 574249) |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2019-08-21 |