| NPI | 1417784778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355170) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CT 12.014365) |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2026-05-11 |