| NPI | 1306416334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 703452) |
| Additional Taxonomies | 163WN0800X Registered Nurse, Neuroscience (Licence: NY 703452-01) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-05-03 |