| NPI | 1215245295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY NONE) |
| Additional Taxonomies | 163WC1500X Registered Nurse Community Health (Licence: NY 495751-1) |
| 163WD0400X Registered Nurse Diabetes Educator (Licence: NY 495751-1) | |
| 163WE0900X Registered Nurse Enterostomal Therapy (Licence: NY 495751-1) | |
| 163WG0000X Registered Nurse General Practice (Licence: NY 495751-1) | |
| 163WP0000X Registered Nurse Pain Management (Licence: NY 495751-1) | |
| 163WW0000X Registered Nurse Wound Care (Licence: NY 495751-1) | |
| 163WX0800X Registered Nurse Orthopedic (Licence: NY 495751-1) | |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2010-09-23 |