| NPI | 1053163329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 433016) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 736709) |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-08-08 |