| NPI | 1043668346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 840167) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 325599) |
| 164X00000X Licensed Vocational Nurse (Licence: TX 331236) | |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2022-03-26 |