| NPI | 1891679692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 740886) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F349642) |
| Enumeration Date | 2025-08-04 |
| Last Update Date | 2025-08-04 |