| NPI | 1215714670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432804) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 747655) |
| Enumeration Date | 2023-09-11 |
| Last Update Date | 2023-09-11 |