NPI | 1679092274 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: WA LP60181016) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 227851) |
Enumeration Date | 2017-09-14 |
Last Update Date | 2017-09-14 |