| NPI | 1417238411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: WA NC10085183) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60171242) |
| Enumeration Date | 2011-09-02 |
| Last Update Date | 2011-09-02 |