| NPI | 1255051587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 351232) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 745604) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2024-05-07 |