| NPI | 1609380294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F345919) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 700811) |
| Enumeration Date | 2017-11-19 |
| Last Update Date | 2024-05-09 |