| NPI | 1104368851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: FL 2681892) |
| Additional Taxonomies | 372600000X Adult Companion |
| Enumeration Date | 2016-11-12 |
| Last Update Date | 2017-06-22 |