| NPI | 1205276201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 1100669) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY RN350579) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2024-04-01 |