| NPI | 1891417887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 310959) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NY 717588) |
| 207R00000X Internal Medicine (Licence: NY 310959) | |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2023-07-22 |