| NPI | 1881137826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F349161) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 724144) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2022-05-02 |