| NPI | 1104089184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 652287) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 292387) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2013-06-25 |