| NPI | 1659656718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 307105-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5188454) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2011-10-19 |