| NPI | 1982035085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP06968200) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 316327) |
| Enumeration Date | 2013-11-28 |
| Last Update Date | 2013-11-28 |