| NPI | 1700361854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: LA 20162552) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 174H00000X Health Educator | |
| 372600000X Adult Companion | |
| 376J00000X Homemaker | |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2018-09-27 |