| NPI | 1487884318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 613841) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2022-07-21 |