| NPI | 1922778554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 244499-1) |
| Additional Taxonomies | 224ZE0001X Occupational Therapy Assistant, Environmental Modification |
| 376K00000X Nurse's Aide (Licence: NY 244499-1) | |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2021-09-15 |