| NPI | 1134732191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA LP61059887) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OR 201909762LPN) |
| 164X00000X Licensed Vocational Nurse (Licence: TX 306983) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-08-28 |