| NPI | 1730507245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 315338) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CT 037069) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2014-04-01 |