| NPI | 1457425613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0000X Registered Nurse General Practice (Licence: NY 642609-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 2583711) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2021-09-29 |