| NPI | 1659031649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DE L2-0024194) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: PA PN301697) |
| Enumeration Date | 2021-12-18 |
| Last Update Date | 2021-12-18 |