| NPI | 1407606650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NM 70682) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 926869) |
| Enumeration Date | 2024-03-22 |
| Last Update Date | 2024-07-31 |