| NPI | 1487159158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MI B650402229974) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: B650402229974) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2018-03-26 |