| NPI | 1275985210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 841723-01) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 315947) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2024-07-25 |