| 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 |