| NPI | 1518252600 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 295261-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 295261-01) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2021-07-19 |