| NPI | 1437679628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 9488093) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 685906) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308731) | |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2026-05-07 |