| NPI | 1689031064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY N40202) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 322082) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2026-09-14 |