| NPI | 1578840393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310357) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 306726-1) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2021-10-14 |