| NPI | 1902341605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 398422-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 332648) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |