| NPI | 1912927047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 342001) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011198) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2018-02-06 |