| NPI | 1467057992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: FL PN5225428) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 376J00000X Homemaker | |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2020-12-02 |