| NPI | 1417643404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 351893) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 724013) |
| Enumeration Date | 2023-04-13 |
| Last Update Date | 2023-08-17 |