| NPI | 1124890306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 720990-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 720998-01) |
| Enumeration Date | 2023-10-23 |
| Last Update Date | 2023-10-23 |