| NPI | 1326693805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 344897) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: NY 635714) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-01 |