| NPI | 1598071789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 224646) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LP 60127828) |
| Enumeration Date | 2010-08-25 |
| Last Update Date | 2010-08-25 |