| NPI | 1164198677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F348746-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 826164-01) |
| 163W00000X Registered Nurse (Licence: AL 1-181389) | |
| Enumeration Date | 2021-08-17 |
| Last Update Date | 2023-03-07 |