| NPI | 1881802981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 2716701) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 271670-01) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2024-06-04 |