| NPI | 1497799399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F310277) |
| Additional Taxonomies | 225700000X Massage Therapist |
| 227900000X Respiratory Therapist, Registered | |
| 363A00000X Physician Assistant (Licence: NY 06795) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2024-01-06 |