| NPI | 1659946671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 798064) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 916743) |
| 163W00000X Registered Nurse (Licence: RI 82250) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2026-03-27 |