| NPI | 1114588001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 308060) |
| Additional Taxonomies | 2279G1100X Respiratory Therapist, Registered, General Care (Licence: NY 010280) |
| Enumeration Date | 2019-06-22 |
| Last Update Date | 2019-06-22 |