| NPI | 1124539168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA NC60765126) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NC60765126) |
| Enumeration Date | 2017-10-17 |
| Last Update Date | 2018-12-14 |