| NPI | 1245418706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 335423) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: NY F3354231) |
| Enumeration Date | 2008-02-07 |
| Last Update Date | 2018-05-22 |