| NPI | 1609578756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: NY 756353) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 351102) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2023-03-22 |