| NPI | 1821539560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308570) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 722187-1) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2025-08-21 |