| NPI | 1164587820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OH pn133030) |
| Enumeration Date | 2006-12-23 |
| Last Update Date | 2008-12-26 |