| NPI | 1134498397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 332973) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 451418) |
| Enumeration Date | 2011-12-17 |
| Last Update Date | 2011-12-17 |