| NPI | 1992170369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 67838-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR17952900) |
| 163W00000X Registered Nurse (Licence: FL RN9700275) | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2026-02-05 |