| NPI | 1356740237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA LPN071497) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 179934) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2014-08-20 |