| NPI | 1891911616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 340566) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001732) |
| 163W00000X Registered Nurse (Licence: NY 601302) | |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2016-08-12 |