| NPI | 1649616632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN 9290432) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 575479) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2013-05-30 |