| NPI | 1629755012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OK 0064110) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OK 064110) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2024-10-09 |