| NPI | 1497876775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 483643) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NY 483643) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |