| NPI | 1336026897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 823079) |
| Additional Taxonomies | 163WC0400X Registered Nurse, Case Management (Licence: NY 823079) |
| Enumeration Date | 2025-08-18 |
| Last Update Date | 2025-08-18 |