| NPI | 1477237238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432657) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 716492) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-12 |