| NPI | 1790936995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA LPN078869) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 293237) |
| Enumeration Date | 2008-10-06 |
| Last Update Date | 2010-04-21 |