| NPI | 1689072571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 949547) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 308284-1) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2024-12-27 |