| NPI | 1720862337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: NY 882437) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 882437) |
| Enumeration Date | 2023-08-23 |
| Last Update Date | 2023-08-23 |