| NPI | 1952601965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 643217) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: NY 260100103070984) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2016-12-11 |