| NPI | 1669860524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MD LP45803) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: DC LPN1005478) |
| Enumeration Date | 2014-12-30 |
| Last Update Date | 2014-12-30 |