| NPI | 1295324051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 351240) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 717225) |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2026-01-27 |