| NPI | 1578432837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: OK 37V735271116) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 3747P1801X Technician, Personal Care Attendant (Licence: OK 37V103297101) | |
| Enumeration Date | 2025-11-04 |
| Last Update Date | 2025-11-04 |