| NPI | 1063846525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431441) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1-106178) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 011504) | |
| Enumeration Date | 2013-09-02 |
| Last Update Date | 2023-09-20 |