| NPI | 1629391966 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 27858) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH PN 130879) |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2019-11-06 |