| NPI | 1952686750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: NY 297793) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP06631000) |
| Enumeration Date | 2011-10-13 |
| Last Update Date | 2011-10-13 |