| NPI | 1922625383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 350195) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 750339) |
| Enumeration Date | 2020-07-01 |
| Last Update Date | 2026-06-15 |