| NPI | 1922795160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: KS 23-015530-122) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: KS 23015530-122) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-19 |