| NPI | 1063821767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: CO 0040457) |
| Additional Taxonomies | 174H00000X Health Educator |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2015-11-10 |