| NPI | 1740890029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: FL 337510) |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: FL 022764700) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2020-08-03 |