| NPI | 1104221985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 819215-01) |
| Additional Taxonomies | 163WI0500X Registered Nurse, Infusion Therapy (Licence: NY 819215-01) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2026-02-17 |