| NPI | 1891394037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY 431743) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 431743) |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2023-07-07 |