| NPI | 1518701051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251B00000X Case Management |
| 251E00000X Home Health | |
| 253Z00000X In Home Supportive Care | |
| Enumeration Date | 2024-06-20 |
| Last Update Date | 2024-06-20 |