| NPI | 1376118927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WH0200X Registered Nurse Home Health (Licence: FL 30212200) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL 3021220) |
| 374U00000X Home Health Aide (Licence: FL 3021220) | |
| 376K00000X Nurse's Aide (Licence: FL 3021220) | |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-05-25 |