| NPI | 1942036918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: LA RN142280) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 876080) |
| Enumeration Date | 2024-09-09 |
| Last Update Date | 2024-09-09 |