| NPI | 1194907899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 22522668) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 239093) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2017-03-03 |