| NPI | 1235719246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 357024) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 782244) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2025-07-14 |