| NPI | 1386210219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 758478) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 758478) |
| Enumeration Date | 2021-06-01 |
| Last Update Date | 2021-06-01 |