NPI | 1912286022 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 646349) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: NV RN68529) |
Enumeration Date | 2011-08-06 |
Last Update Date | 2011-08-06 |