| NPI | 1356581854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 652877) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 288379) |
| Enumeration Date | 2009-02-24 |
| Last Update Date | 2025-02-24 |