| NPI | 1790236727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F349976) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 716515) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2025-04-11 |