| NPI | 1215600960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 347990) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 163W00000X Registered Nurse (Licence: NY 695528) | |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-08-06 |