| NPI | 1972375996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: NY 675168) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NJ 26NR16978900) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ14954700) | |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2023-11-18 |