| NPI | 1689994642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 300271-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN5176415) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2010-06-01 |