| NPI | 1811522733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA CG61053069) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA CG61053069) |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2020-03-11 |