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Individual
MR. CARL DIEDRITCH SICKEROTT JR.
Active
Individual
MR. CARL DIEDRITCH SICKEROTT JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
MHL-092-469
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7804353
—
NC
Enumeration date
08/14/2012
Last updated
08/24/2012
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