| NPI | 1508679564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WI0500X Registered Nurse, Infusion Therapy (Licence: NY 732998) |
| Additional Taxonomies | 163WI0500X Registered Nurse, Infusion Therapy (Licence: CT 158627) |
| Enumeration Date | 2025-01-31 |
| Last Update Date | 2025-01-31 |