| NPI | 1720447691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL pn5179745) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2016-02-19 |
| Last Update Date | 2016-02-19 |