| NPI | 1255874400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 327522-01) |
| Additional Taxonomies | 372600000X Adult Companion (Licence: NY 327522-1) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2022-06-16 |