| NPI | 1801219605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 338832) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 639978) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2025-09-05 |