| NPI | 1376102434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: MI 4703116420) |
| Additional Taxonomies | 372500000X Chore Provider |
| 374U00000X Home Health Aide | |
| 405300000X Prevention Professional (Licence: MI 4703116420) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-06-11 |