| NPI | 1093679094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 312718) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 691129) |
| Enumeration Date | 2025-12-13 |
| Last Update Date | 2026-03-03 |