| NPI | 1811422272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 341839) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: NY 1972572295) |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2017-06-15 |