| NPI | 1174415558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2388825) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV 876596) |
| 163W00000X Registered Nurse (Licence: FL RN9605951) | |
| 163W00000X Registered Nurse (Licence: NY 847964) | |
| Enumeration Date | 2025-07-18 |
| Last Update Date | 2025-07-19 |