| NPI | 1568616233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DE L2-0009235) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: PA PN278818) |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2008-11-07 |