| NPI | 1952005795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: GA LPN067337) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN263572) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2023-03-27 |