| NPI | 1073395968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY AG10230069) |
| Additional Taxonomies | 163WX1500X Registered Nurse, Ostomy Care (Licence: NC 19995) |
| 163WC2100X Registered Nurse, Continence Care (Licence: NC 19995) | |
| 163WE0900X Registered Nurse, Enterostomal Therapy (Licence: NC 19995) | |
| 163WW0000X Registered Nurse, Wound Care (Licence: NC 19995) | |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2024-02-29 |