| NPI | 1861183097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F351278-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 730918) |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2025-01-23 |