| NPI | 1063858561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MA LN95463) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 393840) |
| 164W00000X Licensed Practical Nurse (Licence: MA PN95463) | |
| 164W00000X Licensed Practical Nurse (Licence: RI LPN11308) | |
| Enumeration Date | 2013-05-11 |
| Last Update Date | 2021-08-18 |