| NPI | 1861230096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 353931) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 738796) |
| Enumeration Date | 2024-07-20 |
| Last Update Date | 2024-07-20 |