| NPI | 1871133686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 342657) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 670426) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431683) | |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2021-05-25 |