| NPI | 1790465243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 311435) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: NY 738295) |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2023-08-09 |