| NPI | 1326897034 |
|---|---|
| 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 433112) |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-09-11 |