| NPI | 1760252936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 352510) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 708935) |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-08 |