| NPI | 1326428939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 251B00000X Case Management (Licence: SC 221569) |
| 251C00000X Day Training, Developmentally Disabled Services (Licence: SC 221569) | |
| 251S00000X (Licence: SC 221569) | |
| 253Z00000X In Home Supportive Care (Licence: SC 221569) | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-09 |