| NPI | 1215385943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 329157) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: GA LPN070640) |
| 164W00000X Licensed Practical Nurse (Licence: FL PN5159682) | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-03 |