| NPI | 1235765579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251J00000X Nursing Care |
| Additional Taxonomies | 251E00000X Home Health (Licence: MN 393078) |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2020-03-18 |