| NPI | 1497177968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 271541-1) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: NY 271541-1) |
| Enumeration Date | 2014-01-17 |
| Last Update Date | 2014-01-17 |