| NPI | 1962237644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F355241) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11035007) |
| Enumeration Date | 2024-09-03 |
| Last Update Date | 2024-10-02 |