| NPI | 1538671508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 186791) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LP00056294) |
| Enumeration Date | 2017-10-31 |
| Last Update Date | 2017-10-31 |