| NPI | 1538718069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA 248546) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 248546) |
| 163WE0003X Registered Nurse, Emergency (Licence: NY 776334) | |
| Enumeration Date | 2019-09-07 |
| Last Update Date | 2024-03-29 |