| NPI | 1831886803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 346883) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP49630400) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-04-20 |