| NPI | 1326611336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 349622) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AR R104238) |
| 363LF0000X Nurse Practitioner, Family (Licence: AR 125827) | |
| 163W00000X Registered Nurse (Licence: NY 840996) | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2025-12-12 |