| NPI | 1538777461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431740) |
| Additional Taxonomies | 2086S0102X Surgery, Surgical Critical Care (Licence: NY 431740) |
| Enumeration Date | 2020-07-16 |
| Last Update Date | 2023-07-03 |