| NPI | 1043943541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 349530) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 010863) |
| Enumeration Date | 2022-07-03 |
| Last Update Date | 2025-09-25 |