| NPI | 1730895319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 311833) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 827274) |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2024-10-17 |