| NPI | 1750695615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F341301) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 22604418) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2022-07-21 |