| NPI | 1114211646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 305544) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 672702) |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2013-11-22 |