| NPI | 1811210610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 299714-1) |
| Additional Taxonomies | 251E00000X Home Health (Licence: NY 299714-1) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2010-03-08 |