| NPI | 1710200837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 655546) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 296512) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2014-04-14 |