| NPI | 1689256810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: NY 552257) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NY 552257) |
| Enumeration Date | 2021-04-27 |
| Last Update Date | 2021-04-27 |