| NPI | 1508175092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: PA 16713601) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: PA 16713601) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2010-09-30 |