| NPI | 1780441204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: OR 202102378CNA) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NC61425327) |
| Enumeration Date | 2024-03-01 |
| Last Update Date | 2024-03-01 |