| NPI | 1356961544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: NC 485921) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: NC 218721) |
| Enumeration Date | 2020-04-17 |
| Last Update Date | 2020-04-17 |