| NPI | 1649892738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: NC HC5401) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: NC HC5401) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-05-11 |