| NPI | 1063696532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WS0200X Registered Nurse, School (Licence: NY 535857) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NY 535857) |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2007-12-19 |