| NPI | 1891027942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 614483) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: NY 614483) |
| Enumeration Date | 2010-01-31 |
| Last Update Date | 2010-01-31 |