| NPI | 1376979443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251J00000X Nursing Care |
| 253Z00000X In Home Supportive Care | |
| 332U00000X Home Delivered Meals | |
| 251E00000X Home Health | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-09-20 |
| Last Update Date | 2024-09-12 |