| NPI | 1659751550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 888841) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 320564) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2024-08-02 |