| NPI | 1962161489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: TX 47008359) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: ID 58646) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2021-12-13 |