| NPI | 1639530959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 352113) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 712220-1) |
| Enumeration Date | 2016-03-14 |
| Last Update Date | 2025-09-12 |