| NPI | 1467233908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 311582) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 846503) |
| 163W00000X Registered Nurse (Licence: CT 183637) | |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2024-06-06 |