| NPI | 1851545735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 282933) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 639520-1) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2012-01-17 |