| NPI | 1194569137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 937559) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR24438500) |
| Enumeration Date | 2024-06-24 |
| Last Update Date | 2024-06-24 |