| NPI | 1821887225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 736434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 190733) |
| Enumeration Date | 2025-05-02 |
| Last Update Date | 2025-05-02 |