| NPI | 1043857311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 346201) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 737541) |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2022-12-19 |