| NPI | 1730044645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN336560) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 975440) |
| Enumeration Date | 2025-12-23 |
| Last Update Date | 2025-12-23 |