| NPI | 1538448501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 345351) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 649259) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2020-09-30 |