| NPI | 1477892826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 594291) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 228383) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-05 |