| NPI | 1316152291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: NY 476476-1) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: NY 476476-1) |
| 163WP0200X Registered Nurse Pediatrics (Licence: NY 476476-1) | |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2009-08-27 |