| NPI | 1245516962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F343817) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 642093) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2022-06-15 |