| NPI | 1245853134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F431734-01) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 431734) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2023-07-03 |