| NPI | 1427814987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: NV 862362) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OR 10002822) |
| 164X00000X Licensed Vocational Nurse (Licence: TX 1025139) | |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2024-02-22 |