| NPI | 1457786964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 873854) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 311999) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2025-01-14 |