| NPI | 1225573983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA LP60665514) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 201696) |
| Enumeration Date | 2017-01-04 |
| Last Update Date | 2017-01-04 |