| NPI | 1184721797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F-303393-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 433369) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2016-09-22 |