| NPI | 1912350133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: NE 119512) |
| Additional Taxonomies | 172A00000X Driver (Licence: NE H13581397) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2016-07-22 |
| Last Update Date | 2016-07-22 |