| NPI | 1710364286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F338883-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 612746-1) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2022-11-16 |