| NPI | 1568900561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 728763) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9452977) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-03-03 |