| NPI | 1356668180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 618174-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN 9306729) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-05-04 |