| NPI | 1053834879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F431176-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR15283800) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ15025300) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WA RN60738684) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WA AP60793280) | |
| 163W00000X Registered Nurse (Licence: NY 642933) | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2024-05-17 |