| NPI | 1376930156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 312910) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 686164) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11048524) | |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2026-07-22 |