| NPI | 1871429308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 857217) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2540697) |
| Enumeration Date | 2026-06-22 |
| Last Update Date | 2026-06-22 |