| NPI | 1588903264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310033) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 302155) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2020-12-03 |