| NPI | 1427456813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 684419-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 684419) |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2024-06-12 |