NPI | 1417495771 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 251E00000X Home Health |
Additional Taxonomies | 172V00000X Community Health Worker (Licence: LA HC0011912) |
261QA0600X Clinic/Center, Adult Day Care | |
Enumeration Date | 2017-02-07 |
Last Update Date | 2023-04-20 |