| NPI | 1669052676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WE0003X Registered Nurse, Emergency (Licence: NY 503180) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 503180) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-04-13 |