| NPI | 1558907485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F406840) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 778187) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2025-12-11 |