| NPI | 1174052955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101Y00000X Counselor |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2018-03-17 |