| NPI | 1417482514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 726148) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2279317) |
| 163W00000X Registered Nurse (Licence: CA 95064157) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-05-10 |