| NPI | 1043181159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP49925500) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 352788) |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-09-15 |