| NPI | 1588388763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: GA LPN095122) |
| Enumeration Date | 2022-09-30 |
| Last Update Date | 2022-09-30 |