| NPI | 1851092142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: NY 753548) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 753548) |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-03-14 |