| NPI | 1629448576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F431499-1) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F337808) |
| Enumeration Date | 2015-10-05 |
| Last Update Date | 2021-11-16 |