| NPI | 1952131559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 710374) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR19935000) |
| Enumeration Date | 2024-08-07 |
| Last Update Date | 2024-08-07 |