| NPI | 1982873493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL PT00009763) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 920379) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2023-12-20 |