| NPI | 1295002772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 647220-1) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NY 647220-1) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: NY 647220-1) | |
| Enumeration Date | 2011-11-28 |
| Last Update Date | 2025-07-03 |