| NPI | 1043734502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MI 4704284906) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2022-07-21 |