| NPI | 1124859467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 902966) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: NY 902966) |
| Enumeration Date | 2024-08-09 |
| Last Update Date | 2024-08-09 |