| NPI | 1407246366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: AZ HHA3532) |
| Additional Taxonomies | 251E00000X Home Health (Licence: AZ HHA3734) |
| 251E00000X Home Health (Licence: CO O4U328) | |
| 251E00000X Home Health (Licence: TX 13505) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2019-01-30 |