| NPI | 1538705850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 879784) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 335569) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2023-05-05 |