| NPI | 1184416737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 643288) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001328559) |
| Enumeration Date | 2025-05-20 |
| Last Update Date | 2025-05-20 |