| NPI | 1164963823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 163WH0200X Registered Nurse Home Health (Licence: WV 2322-1967) |
| 374U00000X Home Health Aide (Licence: WV 2322-1967) | |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |