| NPI | 1609500198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY F432339) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 432339) |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2023-07-22 |