| NPI | 1417283185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DE L2-0009786) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: PA PN283217) |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2011-11-03 |