| NPI | 1841822392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: RI 11643) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MA 94732) |
| Enumeration Date | 2020-02-12 |
| Last Update Date | 2020-02-12 |