| NPI | 1265141451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9537801) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 826243) |
| Enumeration Date | 2022-11-16 |
| Last Update Date | 2022-11-16 |