| NPI | 1932464302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 844303) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 306973) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2022-06-09 |