| NPI | 1386312007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310139) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 505927) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2023-01-04 |