| NPI | 1295190163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA LP60591503) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: VT 0111516) |
| 164W00000X Licensed Practical Nurse (Licence: MN 78552-9) | |
| 164W00000X Licensed Practical Nurse (Licence: NY 282333) | |
| 164W00000X Licensed Practical Nurse (Licence: NC 066608) | |
| Enumeration Date | 2015-12-21 |
| Last Update Date | 2015-12-21 |