| NPI | 1710216627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 298458) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: NY 342576930607E) |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2009-12-24 |