| NPI | 1043627755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9254356) |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2021-05-25 |