| NPI | 1467949099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 374U00000X Home Health Aide (Licence: PA 30963601) | |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2018-04-30 |