| NPI | 1932082476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 357694) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 819993) |
| Enumeration Date | 2025-07-30 |
| Last Update Date | 2025-08-13 |