| NPI | 1972059426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: TX 325046) |
| Additional Taxonomies | 372600000X Adult Companion |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2017-02-13 |