| NPI | 1922337278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 336101) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NY 336101) |
| 163W00000X Registered Nurse (Licence: NY 409409) | |
| Enumeration Date | 2009-12-16 |
| Last Update Date | 2011-04-04 |