| NPI | 1780077263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 321500) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP07227600) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2015-03-09 |