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 |