| NPI | 1750644191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F307721) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 715559) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2017-03-22 |