| NPI | 1700120367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 843408) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 3126721) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2025-06-26 |