| NPI | 1790174464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: NY 343396010413E) |
| Additional Taxonomies | 374700000X Technician (Licence: NY 00613392) |
| Enumeration Date | 2015-01-17 |
| Last Update Date | 2015-01-17 |