| NPI | 1457944266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NJ 26NR18007000) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 698206) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2021-02-12 |