| NPI | 1871075408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 783185-01) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 269382) |
| Enumeration Date | 2018-08-30 |
| Last Update Date | 2021-04-08 |