| NPI | 1053821124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: WA PENDING) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: WA P7E6B4P4) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2017-10-03 |