| NPI | 1790254332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA NA60390704) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-12-12 |