| NPI | 1174391072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: OH HCP) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: OH HPC) |
| Enumeration Date | 2023-12-19 |
| Last Update Date | 2023-12-19 |