| NPI | 1750058533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F310721-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 688640) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2022-12-07 |