| NPI | 1912252487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 901059) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 292135) |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2024-12-10 |