| NPI | 1235777426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 346399) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 683595) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F06202031) | |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2023-01-18 |