| NPI | 1366609638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 336723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 597767-1) |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2022-08-05 |