| NPI | 1184922445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F340261-1) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NY 632868) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2016-09-01 |