| NPI | 1013802974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WU0100X Registered Nurse, Urology (Licence: NY 833040-01) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 833040-01) |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-10-13 |