| NPI | 1982039707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 193269) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 193269 DUP) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2014-04-27 |