| NPI | 1831984855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NY P132374) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: WI 1108467) |
| Enumeration Date | 2025-04-10 |
| Last Update Date | 2025-04-10 |