| NPI | 1902113855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 601286) |
| Additional Taxonomies | 163WP0200X Registered Nurse Pediatrics (Licence: NY 601286) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2010-09-13 |