| NPI | 1235641283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA LP60690969) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: VT 025.0123535) |
| 164W00000X Licensed Practical Nurse (Licence: AL 2-052251) | |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2017-10-31 |