| NPI | 1801542543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA Po27962) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: GA LPN0279621) |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2022-02-22 |