| NPI | 1811616246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CT 11387) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: NY F432281-01) |
| Enumeration Date | 2022-08-29 |
| Last Update Date | 2023-01-10 |