| NPI | 1215560008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: MD CNA20200435) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2020-02-19 |