| NPI | 1457810939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: CA 00971943) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: 00971943) |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2019-03-14 |