| NPI | 1093291668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251J00000X Nursing Care |
| Additional Taxonomies | 251E00000X Home Health |
| 253Z00000X In Home Supportive Care | |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| 314000000X Skilled Nursing Facility | |
| 3140N1450X Skilled Nursing Facility, Nursing Care, Pediatric | |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2018-07-17 |