| NPI | 1760275028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F357043-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 802433) |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-08-28 |