| NPI | 1225684558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: NY 745449) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 745449) |
| 163WA0400X Registered Nurse Addiction (Substance Use Disorder) (Licence: NY 745449) | |
| 163WI0500X Registered Nurse Infusion Therapy (Licence: NY 745449) | |
| 163WP0809X Registered Nurse Psychiatric/Mental Health, Adult (Licence: NY 745449) | |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2025-07-16 |