| NPI | 1497342109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 963945) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 338987) |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2024-11-04 |