| NPI | 1568722684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DC LPN1003171) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DC LPN1003171) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2024-09-13 |