| NPI | 1073704334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 238176) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 471763) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2007-08-01 |