| NPI | 1316208770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1007593) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 164W00000X Licensed Practical Nurse (Licence: MD LP50856) | |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2016-05-09 |