| NPI | 1891065223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F336876) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024169792) |
| Enumeration Date | 2012-01-02 |
| Last Update Date | 2012-01-02 |