| NPI | 1487225363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310774) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95183714) |
| 163W00000X Registered Nurse (Licence: FL RN9542421) | |
| 163W00000X Registered Nurse (Licence: NY 739576) | |
| 363L00000X Nurse Practitioner (Licence: NY 310774) | |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2023-10-04 |