| NPI | 1558772954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: NC10081405) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA CG60110999) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |