| NPI | 1992170369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 67838-1) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP06467100) |
| 163W00000X Registered Nurse (Licence: NJ 26NR17952900) | |
| 164W00000X Licensed Practical Nurse (Licence: NY 285341-1) | |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2015-12-10 |