| NPI | 1437746609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 405985) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 800434) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2024-10-11 |