| NPI | 1295564888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MD A00219213) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: MD A00219213) |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2024-08-01 |