| NPI | 1558960245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: GA CN0030061735) |
| Additional Taxonomies | 172A00000X Driver (Licence: GA 061126829) |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2020-10-22 |