| NPI | 1821381682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 657959) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 10295339) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2013-03-26 |