| NPI | 1780953919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 305959) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 577448) |
| Enumeration Date | 2011-12-16 |
| Last Update Date | 2012-04-06 |