| NPI | 1194416594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376J00000X Homemaker (Licence: GA PHCP011463) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: GA PCHP011463) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-05-16 |