| NPI | 1326397498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WI 28545-31) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IL 043.062227) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-09-05 |