| NPI | 1457829830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 796954) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 320351) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2020-07-29 |