| NPI | 1285944694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN9340296) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 654703) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2013-04-04 |