| NPI | 1851711998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 574398) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL rn9378976) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-04-16 |