| NPI | 1720475627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 318019) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 318019-1) |
| Enumeration Date | 2015-04-20 |
| Last Update Date | 2016-04-01 |