| NPI | 1316558596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: NY 979934) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 356658) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2025-11-18 |