| NPI | 1235722992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 617422) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 94192) |
| Enumeration Date | 2021-02-14 |
| Last Update Date | 2024-01-17 |