| NPI | 1043740442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: NV NV20171341089) |
| Additional Taxonomies | 251E00000X Home Health |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2017-06-18 |
| Last Update Date | 2017-06-18 |