| NPI | 1972919371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: KY 2049606) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: IN 27071050A) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2014-07-29 |