| NPI | 1063729465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 614027) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: NY 614027) |
| Enumeration Date | 2010-09-07 |
| Last Update Date | 2010-09-07 |