| NPI | 1740585777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 647316) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 290844) |
| Enumeration Date | 2011-01-23 |
| Last Update Date | 2012-09-21 |