| NPI | 1841605797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 146N00000X Emergency Medical Technician, Basic (Licence: GA E029658) |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care |
| 376K00000X Nurse's Aide (Licence: GA CN0030028021) | |
| Enumeration Date | 2014-06-29 |
| Last Update Date | 2020-02-20 |