| NPI | 1811548019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse, General Practice (Licence: NY 742550-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 349509) |
| Enumeration Date | 2019-09-28 |
| Last Update Date | 2025-06-19 |