| NPI | 1972730992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9583532) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP05883700) |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2024-10-27 |