| NPI | 1295093896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: KY 50176134) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: OH 400605402407) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2012-05-02 |