| NPI | 1225697832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 748650-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 7486501) |
| Enumeration Date | 2019-06-07 |
| Last Update Date | 2019-06-07 |