| NPI | 1194084947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 302861-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP06416100) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-05-15 |