| NPI | 1730822115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350490) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 779775) |
| Enumeration Date | 2022-04-14 |
| Last Update Date | 2022-10-03 |