| NPI | 1396350674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F310007) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: NY 597553) |
| Enumeration Date | 2020-09-13 |
| Last Update Date | 2025-12-12 |