| NPI | 1013162411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: PA PN278647) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MD LP41310) |
| Enumeration Date | 2008-11-26 |
| Last Update Date | 2008-11-26 |