| NPI | 1679154504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse, Home Health (Licence: NY 747854) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 747854) |
| Enumeration Date | 2021-04-21 |
| Last Update Date | 2021-04-21 |