| NPI | 1326502907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 903943) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 903943) |
| 164W00000X Licensed Practical Nurse (Licence: NY 274389) | |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2025-04-10 |