| NPI | 1982938965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NY 282882-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: AZ LP044983) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2009-09-24 |