| NPI | 1609612365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F354319) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 720308) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2025-08-23 |