| NPI | 1255733945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 755166) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 319142) |
| Enumeration Date | 2014-09-24 |
| Last Update Date | 2019-06-19 |