| NPI | 1356112403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F352719-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 805305-01) |
| Enumeration Date | 2024-01-09 |
| Last Update Date | 2024-02-12 |