| NPI | 1740558089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F344394-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 631846) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2020-03-12 |