| NPI | 1134669302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 341430) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 605113) |
| Enumeration Date | 2017-03-07 |
| Last Update Date | 2023-11-27 |