| NPI | 1033663562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL 5258904) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WI 32080) |
| Enumeration Date | 2016-08-13 |
| Last Update Date | 2023-06-23 |