| NPI | 1932370095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432024) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 286063-1) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY F432024-01) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2021-08-23 |