| NPI | 1700704731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 829045) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR15142300) |
| Enumeration Date | 2026-07-07 |
| Last Update Date | 2026-08-06 |