| NPI | 1538803952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: NY F432410) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NY 725481) |
| Enumeration Date | 2022-04-21 |
| Last Update Date | 2023-05-29 |