| NPI | 1134835010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 351296) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 747081) |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2025-01-31 |