| NPI | 1063705903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 623254) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: NY 623254) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2011-05-25 |