| NPI | 1902121007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 662825) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 293266) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2013-06-07 |