| NPI | 1639568975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: SC 251E00000X) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: SC 251G00000X) |
| Enumeration Date | 2015-01-09 |
| Last Update Date | 2015-01-09 |