| NPI | 1003691304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 664080-01) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NY 664080-01) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2023-08-28 |