| NPI | 1447522552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F340770-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 626452) |
| Enumeration Date | 2012-02-04 |
| Last Update Date | 2018-03-17 |