| NPI | 1003069089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 293622) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 610574-01) |
| Enumeration Date | 2008-11-04 |
| Last Update Date | 2024-01-24 |