| NPI | 1598042079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 430909) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 753964) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 430909) | |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2022-09-19 |