| NPI | 1760058648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432026) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 432026) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2023-07-07 |