| NPI | 1528445640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| 251E00000X Home Health | |
| 163WC1500X Registered Nurse, Community Health (Licence: PA RN659219) | |
| 251S00000X | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2023-11-22 |