| NPI | 1558110726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F351816) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 633719) |
| Enumeration Date | 2024-05-18 |
| Last Update Date | 2024-08-22 |