| NPI | 1306589502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse General Practice (Licence: NY 989960) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 339822-01) |
| Enumeration Date | 2022-04-15 |
| Last Update Date | 2025-07-03 |