| NPI | 1982916912 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 296825) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CT 035301) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2010-07-07 |