| NPI | 1558818799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 341549) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 691581) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2018-12-13 |