| NPI | 1275996878 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F346408) | 
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NY 592770) | 
| 363LF0000X Nurse Practitioner, Family (Licence: NY 346408) | |
| Enumeration Date | 2016-03-31 | 
| Last Update Date | 2025-08-19 |