| NPI | 1215579875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 345201) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2023-07-03 |