| NPI | 1639890379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350570) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: NY 763472) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2023-06-01 |