| NPI | 1467795344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 349949) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 651364-1) |
| Enumeration Date | 2013-03-29 |
| Last Update Date | 2022-12-14 |