| NPI | 1710288535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: NY F305496-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 555729-1) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2013-05-13 |