| NPI | 1295171254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 282957) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL 5172476) |
| Enumeration Date | 2013-05-17 |
| Last Update Date | 2013-09-16 |