| NPI | 1609141043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: CO 990339) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO 180328) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2012-09-06 |