| 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 |