| NPI | 1942457965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 337835) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 006241-1) |
| 171100000X Acupuncturist (Licence: NY 003443-1) | |
| 363L00000X Nurse Practitioner (Licence: NY 645452-1) | |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2023-05-18 |