| NPI | 1700225208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 334481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 22 378313) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2013-06-18 |