| NPI | 1558047936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MO 2023021980) |
| Additional Taxonomies | 224Z00000X Occupational Therapy Assistant (Licence: IL 057004598) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-06-22 |