| NPI | 1336415363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431081) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP011973) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F308046-1) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2024-02-14 |