| NPI | 1629502901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide (Licence: MN 1085126-1-HCBS) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MN 108423-1-AFC) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2017-10-13 |