| NPI | 1457054611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 353747) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 813279) |
| Enumeration Date | 2023-03-24 |
| Last Update Date | 2024-05-07 |