| NPI | 1093560062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 354258) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: NY 677901-01) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-07-30 |