| NPI | 1346656808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: GA PHCP011175) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NJ 26NP07138400) |
| Enumeration Date | 2014-07-05 |
| Last Update Date | 2025-03-12 |