| NPI | 1851532972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: DE L2-0008664) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: PA PN279333) |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2009-03-19 |