| NPI | 1346458031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse General Practice (Licence: NY 480399) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: NY 381631) |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-07-08 |