| NPI | 1740536564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 655078-1) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR 16058300) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-07-30 |