| NPI | 1700686383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 312306) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: NY 312306) |
| 163W00000X Registered Nurse (Licence: NY 695264) | |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: NY 312458) | |
| Enumeration Date | 2025-03-13 |
| Last Update Date | 2025-09-26 |