| NPI | 1649012949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F354231-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 814721-01) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-06-10 |