| NPI | 1083377949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 770329) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: NY 770329) |
| 163WS0200X Registered Nurse, School (Licence: NY 770329) | |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2021-10-18 |