| NPI | 1437468337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251J00000X Nursing Care |
| 374U00000X Home Health Aide (Licence: MN 3925502-2) | |
| Enumeration Date | 2010-09-27 |
| Last Update Date | 2010-09-27 |