| NPI | 1962722124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 294669) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 294669) |
| 164X00000X Licensed Vocational Nurse (Licence: NY 294669) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2010-06-10 |