| NPI | 1619353547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308348) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 551525-1) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2025-03-19 |