| NPI | 1922875574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other (Licence: TX MA0000049870) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: TX PTTC3289) |
| 376K00000X Nurse's Aide (Licence: TX NA0060034548) | |
| Enumeration Date | 2023-12-05 |
| Last Update Date | 2023-12-05 |