| NPI | 1619708922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 846125) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 4012134) |
| Enumeration Date | 2024-08-08 |
| Last Update Date | 2025-01-24 |