| NPI | 1063744571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 300231) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN251826) |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2014-02-03 |