| NPI | 1538970785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NY 779260) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: NY 779260) |
| Enumeration Date | 2025-01-16 |
| Last Update Date | 2025-01-16 |