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 |