| NPI | 1902532047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350164) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 740595) |
| Enumeration Date | 2022-07-30 |
| Last Update Date | 2022-08-22 |