| NPI | 1275892234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL PN 5185890) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 219819-1) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2012-05-11 |