| NPI | 1073088407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: MA 474883763) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MA 474883763) |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2018-10-12 |