| NPI | 1851545461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 543519) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 270593) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2010-09-24 |