| NPI | 1124277041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: DE DE00010610206) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: PA 9406859) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |