| NPI | 1982075248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 925368) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 323713) |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2025-07-21 |