| NPI | 1265917348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NY 353083) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 756363) |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2025-02-20 |