| NPI | 1508268186 |
|---|---|
| Former Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: DC LPN1002477) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: DC LPN1002477) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2014-09-25 |