| NPI | 1528642634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 310398) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 722513) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2023-03-20 |