| NPI | 1043161219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 312929) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 851325) |
| Enumeration Date | 2026-02-04 |
| Last Update Date | 2026-07-09 |