| NPI | 1184115222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: GA 060-R-1742) |
| Additional Taxonomies | 251E00000X Home Health (Licence: GA 060-R-1742) |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: GA 060-R-1742) | |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2018-05-24 |