| NPI | 1215411889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 756219) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR20429900) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2018-09-19 |