| NPI | 1386700086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: GA 047-R-0007) |
| Additional Taxonomies | 376J00000X Homemaker (Licence: GA 047-R-0007) |
| 376K00000X Nurse's Aide (Licence: GA 047-R-0007) | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-09 |