| NPI | 1235828716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432676) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MA E895672) |
| 163W00000X Registered Nurse (Licence: NY 732525) | |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2023-08-28 |