| NPI | 1093260242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL PN5162093) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CO PN0332362) |
| 164W00000X Licensed Practical Nurse (Licence: OK 63509) | |
| Enumeration Date | 2016-08-17 |
| Last Update Date | 2016-08-17 |