| NPI | 1851908743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F346857) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 346857) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2025-04-24 |