| NPI | 1023480837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 598481) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26nr15570900) |
| Enumeration Date | 2015-10-21 |
| Last Update Date | 2015-10-21 |