| NPI | 1982277877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: CT 177484) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 632595) |
| Enumeration Date | 2021-07-20 |
| Last Update Date | 2021-07-20 |