| NPI | 1114359593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 695208) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 315113) |
| 246RP1900X Technician, Pathology Phlebotomy (Licence: NY B3Q6Z7G2) | |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2015-02-06 |