| NPI | 1134467640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OK 64924) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 174592) |
| 164W00000X Licensed Practical Nurse (Licence: NY 300937) | |
| 225700000X Massage Therapist (Licence: OK 24664) | |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2015-11-20 |