| NPI | 1740779404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ND 16092) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 666975) |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2018-05-08 |