| NPI | 1609341890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 344048) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 632189) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2019-02-07 |