| NPI | 1205145737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP06048500) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: PA PN281579) |
| Enumeration Date | 2010-10-01 |
| Last Update Date | 2010-10-01 |