| NPI | 1083066294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: MN 1081808) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MN 1081808) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2016-07-12 |