| NPI | 1003612482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: WI WI037940401582) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: MN 10866195) |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2025-02-24 |