| NPI | 1255965307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: PA 45043601) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: PA 45043601) |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2020-02-27 |