| NPI | 1306556329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350797) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 766411) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2024-04-18 |