| NPI | 1093577157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 849612) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR24751900) |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2024-01-24 |