| NPI | 1093041501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F351785) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 719660) |
| 164W00000X Licensed Practical Nurse (Licence: NY 289076) | |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2023-04-28 |