| NPI | 1477283638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 740011-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 740071) |
| Enumeration Date | 2022-06-12 |
| Last Update Date | 2022-06-12 |