| NPI | 1861383820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 357491) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61576608) |
| 163W00000X Registered Nurse (Licence: NY 962375) | |
| 163W00000X Registered Nurse (Licence: CT 211405) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2025-09-17 |