| NPI | 1235631342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CT 221191) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CT 040075) |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2025-01-21 |