| NPI | 1609543008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG61213981) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA CG61213981) |
| Enumeration Date | 2021-08-24 |
| Last Update Date | 2021-08-24 |