| NPI | 1962060897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NY 483799) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NY 483799) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2021-10-26 |