| NPI | 1518091123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 493008) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR09373600) |
| 171100000X Acupuncturist (Licence: NY 001624) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |