| NPI | 1639064173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 251J00000X Nursing Care | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 247200000X Technician, Other | |
| Enumeration Date | 2025-06-12 |
| Last Update Date | 2025-06-12 |