| NPI | 1447009485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11039537) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY f353871) |
| Enumeration Date | 2024-05-14 |
| Last Update Date | 2025-11-04 |