| NPI | 1366806994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F3814671) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 4820841) |
| Enumeration Date | 2016-04-10 |
| Last Update Date | 2016-04-10 |