| NPI | 1184055337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: PA 05840501) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: PA 24653601) |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2015-08-11 |