| NPI | 1922492941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: AZ LP051537) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 4703114231) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-02-28 |