| NPI | 1922264555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: RI LPN09901) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MA 68043) |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2008-08-04 |