| NPI | 1225901994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 938916) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 234690) |
| Enumeration Date | 2025-09-27 |
| Last Update Date | 2025-10-01 |