NPI | 1093202863 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: TX 325857) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LP60845138) |
Enumeration Date | 2018-04-17 |
Last Update Date | 2018-04-17 |