| NPI | 1619237450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY F430592-1) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: NY 430592) |
| Enumeration Date | 2012-05-28 |
| Last Update Date | 2023-07-07 |