| NPI | 1750306676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341342-1) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY X010830-1) |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: NY F341342-1) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2018-03-14 |