| NPI | 1275336372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 360250) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 197516) |
| 163W00000X Registered Nurse (Licence: NY N36792-01) | |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2026-06-17 |