| NPI | 1215452743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308230-1) |
| Enumeration Date | 2017-08-05 |
| Last Update Date | 2024-04-25 |