| NPI | 1932941226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MD LP44506) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MD LP4405) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2024-06-15 |