| NPI | 1013551720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345174) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 570536) |
| 163WE0003X Registered Nurse, Emergency (Licence: NY 570536) | |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2022-12-14 |