| NPI | 1811214331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL RN 9305740) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 626580-1) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2010-04-23 |