| NPI | 1760153985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F432158) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432158) |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |