| NPI | 1346794971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431469) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 307811) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2019-02-26 |