| NPI | 1275014516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: CO 334490) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: GA LPN086421) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-08-24 |