| NPI | 1285029389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 251326-1) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NY 251326-1) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |