| NPI | 1396377677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345435) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010488) |
| Enumeration Date | 2020-02-05 |
| Last Update Date | 2025-05-08 |