| NPI | 1952942393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 345120) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95028502) |
| 163W00000X Registered Nurse (Licence: NY 779911) | |
| 163W00000X Registered Nurse (Licence: MA RN2261111) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2261111) | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2020-11-06 |