| NPI | 1538878194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F350544) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 736595) |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2023-09-16 |