| NPI | 1902314412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 329330) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: NY 329330) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2018-02-14 |