| NPI | 1053094383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 719948) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: NJ 26NP07761700) |
| 164X00000X Licensed Vocational Nurse (Licence: PA PN306930) | |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-08-11 |