| NPI | 1285833145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 349482) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x010992-1) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2022-04-20 |