| NPI | 1962829531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY F342271-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 630062) |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2023-05-19 |