| NPI | 1992540835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 936324) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR25823400) |
| Enumeration Date | 2024-07-01 |
| Last Update Date | 2024-07-01 |