| NPI | 1619777992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2314561) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9531695) |
| 163W00000X Registered Nurse (Licence: CA 95155963) | |
| 163W00000X Registered Nurse (Licence: NY 836241) | |
| Enumeration Date | 2025-03-17 |
| Last Update Date | 2025-03-17 |