| NPI | 1063207900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11038869) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 990887) |
| 163W00000X Registered Nurse (Licence: FL 9618821) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 357293) | |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2025-09-08 |