| NPI | 1467093880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 309500) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 435532) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309500) | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2023-07-03 |