| NPI | 1487086922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 166532) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2020-09-09 |