| NPI | 1023641594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309528) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1175818) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2025-07-03 |