| NPI | 1417889783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 987219) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM 79305) |
| Enumeration Date | 2026-06-01 |
| Last Update Date | 2026-06-01 |