| NPI | 1265752471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 22 498001) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC R 102307) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2010-06-10 |