| NPI | 1558016105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 619779) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: NY 619779) |
| Enumeration Date | 2022-02-12 |
| Last Update Date | 2022-02-12 |