| NPI | 1083400238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: NY 795640) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F356214-01) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-11-14 |