| NPI | 1558697904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: PA PN279188) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP05641000) |
| Enumeration Date | 2009-10-20 |
| Last Update Date | 2009-10-20 |