| NPI | 1982995833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 656746) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 2487281) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2021-06-21 |