| NPI | 1336566173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: DC NA00605817) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA10553) |
| Enumeration Date | 2014-03-18 |
| Last Update Date | 2014-04-06 |