| NPI | 1669146569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432106) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 719330) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2021-09-24 |