| NPI | 1144593906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA lpn073147) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: SC 43932) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |