| NPI | 1316839673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: NJ HP0368400) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: NJ 26NR19114400) |
| Enumeration Date | 2025-07-19 |
| Last Update Date | 2025-08-25 |