| NPI | 1154667871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 543889-1) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: NY 543889-1) |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2012-12-27 |