| NPI | 1225472335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11004656) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F348471-01) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024197968) | |
| 376K00000X Nurse's Aide | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2026-08-18 |