| NPI | 1225887524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 354416) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 809914) |
| Enumeration Date | 2024-05-17 |
| Last Update Date | 2024-06-04 |