| NPI | 1639273238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 393141) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 300816) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |