| NPI | 1902267453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 431099) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 707761) |
| Enumeration Date | 2016-03-11 |
| Last Update Date | 2017-03-05 |