| NPI | 1396454435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F352584-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 530505) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2024-02-01 |