| NPI | 1992314439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251J00000X Nursing Care (Licence: NY 651299) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: NY F346860-01) |
| Enumeration Date | 2020-07-30 |
| Last Update Date | 2021-07-23 |