| NPI | 1235295775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 381435) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: NY f381435) |
| 363L00000X Nurse Practitioner (Licence: NY 381435) | |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2019-05-17 |