| NPI | 1174940514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: CA 00885714) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: UT 001) |
| Enumeration Date | 2014-03-24 |
| Last Update Date | 2014-03-24 |