| NPI | 1093068280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 660852) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 302731) |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2012-10-25 |