| NPI | 1720828429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 355152) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NM 81732) |
| 163W00000X Registered Nurse (Licence: NY 941836) | |
| Enumeration Date | 2024-05-30 |
| Last Update Date | 2024-09-17 |