| NPI | 1215176094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307896) |
| Additional Taxonomies | 133V00000X Dietitian, Registered (Licence: NY 006546) |
| Enumeration Date | 2009-02-18 |
| Last Update Date | 2016-12-27 |