| NPI | 1487925319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 307577-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 307577) |
| Enumeration Date | 2012-01-24 |
| Last Update Date | 2019-03-21 |