| NPI | 1750701272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MN L36999-0) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: MN L36999-0) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |