| NPI | 1770965436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F309119) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 695125) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2019-07-28 |