| NPI | 1205683034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: WI 0020011) |
| Additional Taxonomies | 251E00000X Home Health (Licence: WI 0020019) |
| Enumeration Date | 2024-04-30 |
| Last Update Date | 2024-04-30 |