| NPI | 1518204171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: DC 252441650790) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: DC 252441650790) |
| 174H00000X Health Educator (Licence: DC 252441650790) | |
| 251E00000X Home Health | |
| 253Z00000X In Home Supportive Care (Licence: DC 252441650790) | |
| 302R00000X Health Maintenance Organization (Licence: DC 252441650790) | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2013-01-15 |