| NPI | 1639384910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 341323) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003520) |
| 163W00000X Registered Nurse (Licence: NY 630632) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2017-04-20 |