| NPI | 1669868667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F-355826-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 22692069) |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2026-06-14 |