| NPI | 1841650454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: IL 043115141) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IN 27071194A) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |