| NPI | 1679088579 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 327159-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 327159) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2017-12-13 |