| NPI | 1184144032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment | |
| 310400000X Assisted Living Facility | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 372600000X Adult Companion | |
| 385H00000X Respite Care | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2017-06-22 |