| NPI | 1740552918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OR 201130664LPN) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 303813) |
| 164X00000X Licensed Vocational Nurse (Licence: CA 264258) | |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2012-02-03 |