| NPI | 1013141381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MO 2007033466) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 211217) |
| Enumeration Date | 2009-05-14 |
| Last Update Date | 2009-05-14 |