| NPI | 1720532708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 356834) |
| Additional Taxonomies | 372500000X Chore Provider (Licence: NY 601016) |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2025-05-25 |