| NPI | 1821734054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9599858) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 832394) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2024-11-24 |