| NPI | 1851896195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY f349415) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 741733) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2022-05-06 |