| NPI | 1174198303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310323) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 746535) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2026-03-25 |