| NPI | 1184859712 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 649535-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 291028) |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2011-11-01 |