| NPI | 1245533892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MT 39675) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI L1495260) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2010-12-20 |