| NPI | 1407693401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: PA PN267643) |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: CHT3984) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2024-07-09 |