| NPI | 1235765843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 601839) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431684) |
| Enumeration Date | 2020-03-15 |
| Last Update Date | 2023-11-15 |