| NPI | 1255827929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: NY F343205) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F343205) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F343205) | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2020-10-13 |