| NPI | 1144738949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431321) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 686256) |
| 2086S0127X Surgery, Trauma Surgery (Licence: NY 431321) | |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2023-06-30 |