| NPI | 1720895220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY F433186) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: PA SP031408) |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2025-08-15 |