| NPI | 1114440328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: FL RN9312063) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2025-09-11 |