| NPI | 1699704072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F339967) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011001) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-02-06 |