| NPI | 1912428921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 808700-01) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 328137-01) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2025-05-05 |