| NPI | 1760684443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: DE L10031564) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 540403) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2007-07-08 |