| NPI | 1770256463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 432051) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F432051-01) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2021-07-29 |