| NPI | 1013531938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY F383386-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 717883) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: NY 383386) | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2023-07-22 |