| NPI | 1477804151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 382974) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 740009-1) |
| 171100000X Acupuncturist (Licence: NY 25004916) | |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2024-10-07 |