| NPI | 1750084448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 561703-01) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: NY 561703-01) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2023-03-23 |