| NPI | 1437643566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 343488) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 575973) |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2018-08-21 |