| NPI | 1104594407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F433099-01) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NH 086162-23) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2024-09-20 |