| NPI | 1558156323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 356384) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 746530) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 356384) | |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2025-09-16 |