| NPI | 1851592760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: PA TLPN003931) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: DE L2-009458) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-08 |