| NPI | 1528639424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432095) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 703112) |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2021-08-23 |