| NPI | 1174121230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA NA61083754) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NA61083754) |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2020-10-12 |