| NPI | 1720354434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F305502-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 234412) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 512108-1) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2012-05-08 |