| NPI | 1932085990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: VA 0001319348) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 772350) |
| Enumeration Date | 2025-08-14 |
| Last Update Date | 2025-08-14 |