| NPI | 1154737435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 677728) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 677728) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2025-03-17 |