| NPI | 1164029732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374K00000X Religious Nonmedical Practitioner |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: AR 092134946) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2020-10-06 |