| NPI | 1881479913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 35740701) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA 033545) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2025-08-07 |