| NPI | 1306665567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 360554) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 803799) |
| Enumeration Date | 2024-10-05 |
| Last Update Date | 2026-07-28 |