| NPI | 1023467321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 655291-1) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NY 655291-1) |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2023-06-05 |