| NPI | 1063258929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 674524) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9615989) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-01 |