| NPI | 1760615058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WG0600X Registered Nurse, Gerontology (Licence: NY 576345) |
| Additional Taxonomies | 163WR0400X Registered Nurse, Rehabilitation (Licence: NY 576345) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2009-09-02 |