| NPI | 1053897801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431328) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 431328) |
| Enumeration Date | 2018-07-16 |
| Last Update Date | 2023-06-30 |