| NPI | 1629377445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NJ 26nr11395600) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 546207-1) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2011-03-18 |