| NPI | 1205425204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355594) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 969351) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ01094100) | |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2025-10-22 |