| NPI | 1720423536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OR 201230678LPN) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WV 28704) |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2013-05-07 |