| NPI | 1184502007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 910764) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: RI RN80291) |
| Enumeration Date | 2025-08-27 |
| Last Update Date | 2025-08-27 |