| NPI | 1851284186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 312343) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 724169) |
| Enumeration Date | 2025-06-03 |
| Last Update Date | 2026-02-20 |