| NPI | 1699929356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 667852) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 273276) |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2023-04-04 |