| NPI | 1245418706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 335423) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 475837) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2024-06-25 |