| NPI | 1710835640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 777765-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR24855100) |
| Enumeration Date | 2026-03-17 |
| Last Update Date | 2026-03-17 |