| NPI | 1245711944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355587) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043406) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2026-04-13 |