| NPI | 1306078357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 622351) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 266186) |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2010-04-06 |