| NPI | 1811625205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY 432341) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NY 681683) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2023-07-22 |