| NPI | 1366015216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: OK css0800) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OK css0800) |
| 374U00000X Home Health Aide (Licence: OK css0800) | |
| 385H00000X Respite Care (Licence: OK css0800) | |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2021-07-19 |