| NPI | 1831818533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350266) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 853793) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2022-08-30 |