| NPI | 1124389978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP06404600) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 306739) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2012-06-07 |