NPI | 1902117567 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163WP0200X Registered Nurse, Pediatrics (Licence: NY 612828) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 612828) |
Enumeration Date | 2010-06-29 |
Last Update Date | 2010-06-29 |