| NPI | 1639619141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL PN5209623) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MN L 080780-5) |
| 164W00000X Licensed Practical Nurse (Licence: ME LPN03910) | |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2017-03-02 |