| NPI | 1437741402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F347403) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 692655) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-09-07 |