| NPI | 1932250107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 343176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009616) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2022-09-06 |