| NPI | 1689364622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 286410) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CT 41343) |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2023-05-12 |