| NPI | 1104303106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: VA 181590) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: VA 181590) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2018-07-23 |