| NPI | 1063221679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 308194) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 312431) |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-01-07 |