| NPI | 1003059718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MD LP43734) |
| 374U00000X Home Health Aide (Licence: DC HHA4022) | |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2023-04-11 |